Thank you for everyone’s ongoing contributions!
The patient underwent further intra-abdominal surgery without significant bleeding complications following the management below:
- Vitamin K 10mg IV
- Co-trimoxazole stopped
- IVIg 2g/kg over 2 days
- Platelet transfusion (random ABO and D compatible with good 15 minute increment – plt count went from 25 to 51)
- 2 units packed red cells
Unfortunately 3 days later our 65 year old patient has deteriorated and is now on critical care having been intubated and ventilated. A CTPA and CT abdo-pelvis was performed and this has shown:
- Bilateral segmental PEs
- Fully occluded portal vein thrombosis
- Mild improvement regarding appearance of pancreatitis
Repeat bloods are as follows:
- Hb 78 Plts 39 WCC 5
- PT 18 APTT 39 Clauss fib 3
- eGFR 31 Bili 125 ALT 320 Alk phos 110 CRP 265
- How would you manage our patient now (from haem perspective)?
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